Ovarian cancer kills more women each year than all other gynecologic malignancies combined. Early detection of ovarian cancer is the key to improved survival outcomes. Unfortunately, an effective screening test for ovarian cancer does not currently exist for women in the general population. It may be possible, however, to improve early detection of ovarian cancer through systematic collection and evaluation of data on women's experience of symptoms including bloating, increased abdominal size, pelvic or abdominal pain, and difficulty eating, and feeling full quickly. A symptom index has recently been developed that uses the reports of these symptoms when reported in a specific pattern. Recently published analyses have determined the index to be associated with ovarian cancer, and to rarely occur in the absence of this disease. This project will pilot the use of this index prospectively in a primary care clinic to identify a group of women at elevated-risk of having ovarian cancer to undergo symptom- triggered referral for diagnostic tests for ovarian cancer early detection. It will be the first attempt to use symptoms prospectively and will also determine the percentages of women in a primary care clinic population between the ages of 40-49 and 50 over thus referred. Furthermore, we will examine the ovarian cancer related health outcomes experienced by women with positive versus negative symptom index scores. The results of early diagnostic procedures in referred women will be examined, and passive follow-up used to assure the identification of any women in the clinic population who was diagnosed with ovarian cancer within six months of the index visit. In addition, we will collect pilot data for a future RO1 study that would evaluate the potential effectiveness of using these procedures as a way of "screening" average risk women for ovarian cancer to increase detection of disease at early stages. If such a strategy proved effective, symptom-triggered referral would provide an invaluable tool for early identification of ovarian cancer by primary care doctors and nurses. The proposed project will pilot the use of a novel approach to the early detection of ovarian cancer in a primary care clinic serving average-risk women. Early detection efforts would be based on the identification of a pattern of symptoms likely to be associated with ovarian cancer that would trigger referral for early diagnostic testing. Outcomes of such an approach for women with and without the identified pattern of symptoms will be examined.